24-1279m Prevent the Spread of Tuberculosis During Regular Check-Ups
Date: 12/19/24
Screening members in primary care settings can help address increasing incidence rates for this preventable and curable disease
Health Net requires physicians and other health care providers to offer tuberculosis (TB) screening assessments for members ages 18 and older if risk factors are identified.
TB assessment criteria
Use the following criteria to assess Medi-Cal members for TB risk:
1. Adult members who receive primary care services in a facility, clinic, center, office, or other setting where primary care services are provided, shall be offered a TB risk assessment and TB screening test, if TB risk factors are identified, based on the latest screening indications recommended by the U.S. Preventive Services Task Force, unless the physician or other provider reasonably believes that one of the following conditions applies:
- The member is being treated for a life-threatening emergency.
- The member has previously been offered or has been the subject of a TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test, unless the physician or other provider determines that they should be offered again.
- The member has a documented, previously positive Interferon-Gamma Release Assays test or has previously tested positive for a latent tuberculosis infection (LTBI).
- The member lacks capacity to consent to the assessment or test, and/or consent cannot be obtained from a person legally authorized to make medical decisions on the patient’s behalf.
- The member is being treated in the emergency department of a general acute care hospital.
2. If a member accepts the offer of the TB screening test and the test is positive, physicians or other providers are required to offer the member follow-up care or refer the member to a provider who can provide follow-up care.
Why is TB screening important?
TB disease is an illness caused by the bacteria mycobacterium tuberculosis. TB usually affects the lungs and spreads through the air when a person sick with TB coughs. Not everyone infected with the bacteria becomes sick. People that have been infected but are not sick have LTBI. People with LTBI can become sick with TB disease in the future if they are not treated. Because TB disease is contagious, early detection and treatment to prevent the spread of this life-threatening disease onto others is critical.
How to learn more
The changes to TB screenings described in this update ensure compliance with Assembly Bill 2132 enacted on September 29, 2024. For more information, visit the California Legislative Information website.
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Behavioral health providers can call 844-966-0298.
Line of business | Phone number | |
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medi-Cal (including CS and ECM providers) | N/A |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.